2011 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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SecureHorizons MedicareDirect Rx (PFFS) in AR - H5435-014-0 Benefit Details |
Ashley | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in AR - H5435-014-0 Benefit Details |
Bradley | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in AR - H5435-014-0 Benefit Details |
Dallas | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in AR - H5435-014-0 Benefit Details |
Hempstead | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in AR - H5435-014-0 Benefit Details |
Howard | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in AR - H5435-014-0 Benefit Details |
Izard | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in AR - H5435-014-0 Benefit Details |
Lee | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in AR - H5435-014-0 Benefit Details |
Nevada | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in AR - H5435-014-0 Benefit Details |
St. Francis | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in AR - H5435-014-0 Benefit Details |
Van Buren | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in CA - H5435-014-0 Benefit Details |
Del Norte | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in CA - H5435-014-0 Benefit Details |
Humboldt | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in CA - H5435-014-0 Benefit Details |
Modoc | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in CA - H5435-014-0 Benefit Details |
Plumas | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in CA - H5435-014-0 Benefit Details |
Siskiyou | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in CA - H5435-014-0 Benefit Details |
Trinity | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Baldwin | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Berrien | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Burke | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Butts | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Calhoun | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Camden | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Carroll | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Catoosa | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Chattahoochee | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Chattooga | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Clarke | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Clay | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Clinch | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Crisp | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Dade | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Decatur | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Elbert | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Fannin | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Gilmer | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Glynn | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Grady | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Greene | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Habersham | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Hancock | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Haralson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Hart | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Heard | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Irwin | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Jefferson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Lamar | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Lanier | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Lumpkin | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Macon | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Marion | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
McDuffie | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
McIntosh | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Meriwether | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Morgan | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Oconee | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Oglethorpe | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Pickens | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Pike | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Quitman | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Randolph | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Schley | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Stewart | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Sumter | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Terrell | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Thomas | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Tift | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Towns | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Troup | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Turner | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Union | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Walker | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Warren | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Washington | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in GA - H5435-014-0 Benefit Details |
Webster | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ID - H5435-014-0 Benefit Details |
Blaine | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ID - H5435-014-0 Benefit Details |
Custer | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ID - H5435-014-0 Benefit Details |
Franklin | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ID - H5435-014-0 Benefit Details |
Jerome | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ID - H5435-014-0 Benefit Details |
Lemhi | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ID - H5435-014-0 Benefit Details |
Lincoln | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Adair | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Buena Vista | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Calhoun | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Carroll | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Cerro Gordo | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Cherokee | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Clay | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Decatur | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Dickinson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Emmet | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Hancock | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Howard | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Humboldt | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Ida | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Kossuth | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Lyon | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Mitchell | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
O'Brien | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Osceola | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Palo Alto | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Pocahontas | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Ringgold | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Sac | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Sioux | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Union | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Webster | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Winnebago | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in IA - H5435-014-0 Benefit Details |
Worth | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ME - H5435-014-0 Benefit Details |
Piscataquis | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ME - H5435-014-0 Benefit Details |
Somerset | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ME - H5435-014-0 Benefit Details |
Washington | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MO - H5435-014-0 Benefit Details |
Ozark | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Blaine | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Carter | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Chouteau | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Custer | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Daniels | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Dawson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Deer Lodge | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Fallon | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Garfield | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Golden Valley | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Hill | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Judith Basin | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Liberty | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Lincoln | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Madison | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
McCone | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Musselshell | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Petroleum | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Phillips | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Pondera | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Powder River | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Prairie | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Richland | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Roosevelt | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Rosebud | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Sheridan | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Silver Bow | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Teton | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Toole | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Treasure | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Valley | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Wheatland | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in MT - H5435-014-0 Benefit Details |
Wibaux | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in NH - H5435-014-0 Benefit Details |
Belknap | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in NH - H5435-014-0 Benefit Details |
Carroll | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in NH - H5435-014-0 Benefit Details |
Cheshire | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in NH - H5435-014-0 Benefit Details |
Coos | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in NH - H5435-014-0 Benefit Details |
Grafton | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in NH - H5435-014-0 Benefit Details |
Hillsborough | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in NH - H5435-014-0 Benefit Details |
Merrimack | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in NH - H5435-014-0 Benefit Details |
Rockingham | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in NH - H5435-014-0 Benefit Details |
Strafford | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in NH - H5435-014-0 Benefit Details |
Sullivan | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Adams | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Benson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Billings | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Bottineau | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Bowman | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Burke | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Burleigh | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Cavalier | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Divide | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Dunn | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Eddy | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Emmons | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Foster | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Golden Valley | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Grant | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Hettinger | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Kidder | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Logan | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
McHenry | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
McIntosh | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
McKenzie | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
McLean | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Mercer | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Morton | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Mountrail | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Nelson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Oliver | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Pembina | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Pierce | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Ramsey | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Renville | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Rolette | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Sheridan | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Sioux | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Slope | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Stark | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Towner | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Walsh | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Ward | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Wells | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in ND - H5435-014-0 Benefit Details |
Williams | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Aurora | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Beadle | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Bennett | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Bon Homme | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Brule | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Buffalo | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Butte | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Campbell | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Charles Mix | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Clark | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Clay | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Codington | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Corson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Custer | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Davison | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Dewey | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Douglas | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Edmunds | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Fall River | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Faulk | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Gregory | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Haakon | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Hand | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Hanson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Harding | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Hughes | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Hutchinson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Hyde | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Jackson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Jerauld | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Jones | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Kingsbury | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Lake | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Lawrence | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Lyman | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
McCook | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
McPherson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Meade | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Mellette | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Miner | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Pennington | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Perkins | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Potter | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Sanborn | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Shannon | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Spink | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Stanley | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Sully | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Todd | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Tripp | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Turner | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Union | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Walworth | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Washabaugh | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Yankton | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in SD - H5435-014-0 Benefit Details |
Ziebach | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Bandera | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Bee | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Blanco | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Brewster | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Brooks | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Brown | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Caldwell | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Calhoun | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Camp | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Colorado | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Comanche | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Crane | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Culberson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Delta | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
DeWitt | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Dimmit | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Duval | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Eastland | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Erath | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Fayette | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Franklin | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Frio | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Gillespie | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Goliad | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Gonzales | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Grimes | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Hopkins | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Hudspeth | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Jack | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Jackson | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Jeff Davis | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Jim Wells | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Karnes | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Kenedy | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Kerr | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
La Salle | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Lavaca | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Live Oak | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Loving | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Matagorda | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Maverick | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
McMullen | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Pecos | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Presidio | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Rains | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Real | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Reeves | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Refugio | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Somervell | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Terrell | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Uvalde | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Victoria | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Ward | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Wharton | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Winkler | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Wise | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in TX - H5435-014-0 Benefit Details |
Zavala | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Amherst | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Augusta | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Bedford | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Bedford City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Brunswick | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Buena Vista City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Campbell | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Carroll | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Culpeper | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Danville City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Emporia City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Fauquier | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Galax City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Greensville | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Halifax | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Harrisonburg City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Henry | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Lexington City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Lynchburg City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Martinsville City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Mecklenburg | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Patrick | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Pittsylvania | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Rockbridge | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Rockingham | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
South Boston City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Spotsylvania | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Staunton City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in VA - H5435-014-0 Benefit Details |
Waynesboro City | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
SecureHorizons MedicareDirect Rx (PFFS) in WI - H5435-014-0 Benefit Details |
Kewaunee | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
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MOOP for A & B |
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SecureHorizons MedicareDirect Rx (PFFS) in WI - H5435-014-0 Benefit Details |
Oconto | $20.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic Drugs: $6.00 Generic and Preferred Brand Drugs: $45.00 Non-Preferred Generic and Non-Preferred Brand Drug: $88.00 Specialty Tier Drugs: 33% | $5,200 Browse Formulary | |||||
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